Topics Related to Medicaid Managed Care

Effective Dec. 1, 2023, updates increased treatment visit limits for beneficiaries aged 21 and older. The home health ordering practitioner reference was also updated.

Effective June 1, 2024, CPT codes are newly eligible for coverage.

Providers should work with the Tailored Plans and Tailored Care Managers to support Medicaid beneficiaries transitioning to 1915(i) services.

AMH Provider Manual May 2024 reflects all program modifications and changes that impact provider contracts and operations.

This bulletin applies to NC Medicaid Managed Care Standard Plans.

Provider Data Management / Credentialing Verification Organization (PDM/CVO) Solution New Launch Date of 2026.
Includes information on the New Launch Date for PDM/CVO, Healthy Opportunities Pilot, Provider Fact Sheets, Reverification Updates and more.

Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation

Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.

Members may now select to receive Tailored Care Management from a provider with Transition to Community Living Distinction.